patients first: a roadmap to strengthen home and...

Patients FirstA Roadmap to Strengthen Home and Community Care

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Ministère de la Santé et des Soins de longue duréeBureau du ministreÉdifice Hepburn, 10e étage80, rue GrosvenorToronto ON M7A 2C4Tél. 416 327-4300Téléc. 416 326-1571www.ontario.ca/sante

Ministry of Health and Long-Term CareOffice of the Minister10th Floor, Hepburn Block80 Grosvenor StreetToronto ON M7A 2C4Tel. 416 327-4300Fax 416 326-1571www.ontario.ca/health

Message from the Minister of Health and Long-Term Care

As our population ages, home and community care is becoming especially important. Ontarians want

and deserve a health care system that helps them live independently at home – where we know they

want to be.

Strengthening home and community care is a hallmark of our government’s efforts to transform health

care. It is a fundamental part of our Patients First: Action Plan for Health Care. Our 2015 Budget proposed

continued funding increases for the sector over the next three years.

Our plan to transform home and community care in Ontario is bold. Our timelines are clear. We will

introduce greater consistency in care, a better understanding of the services available, more support for

caregivers and, ultimately, better access to the right care for those who need it most.

Patients First: A Roadmap to Strengthen Home and Community Care is the first phase of our plan to

remake the home and community care sector. It outlines the steps we are taking to improve the care our

loved ones receive. It is informed by the work of the ministry’s expert group on home and community care,

led by Gail Donner, and its report, Bringing Care Home.

Like the expert group’s report, the first phase of our plan is focused on the experience of those receiving

care at home or in the community. This phase is not about changes to the foundation of the system. This is

intentional; we believe that clients and caregivers are our first priority. Changes to the system’s structure

and governance will follow in a natural progression, as necessary.

This roadmap outlines the path we will follow for each of the next three years as we transform the home

and community care sector. It includes new programs we intend to create and the results we will achieve

on behalf of Ontarians.

http://www.ontario.ca/health

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This is a journey we cannot take alone. We look forward to continuing to consult widely with our

partners in the home and community care sector as well as with those receiving care, their caregivers and

advocates. Together, we will improve the care we provide to our loved ones at home and in the community

because that’s what it means to put Patients First.

Dr. Eric Hoskins

Minister of Health and Long-Term Care

May 2015

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Goals for Strengthening Home and Community Care

Put Clients and Caregivers FirstThe planning and delivery of home and community care is client and caregiver-centred. Everyone who has needs that can be reasonably met in the home or community will receive support to do so.

Improve Client and Caregiver Experience Clients and caregivers understand the support they can expect and they experience a timely, responsive system. Service delivery information is publicly available and easily accessible.

Drive Greater Quality, Consistency and TransparencyClients receive consistent, high quality care throughout the province. Care is informed by experts and evidence. Home and community care programs use standardized tools and supports to strengthen the quality of services and programs delivered.

Plan for and Expand CapacityInvestments focus on increasing capacity and improving performance in the home and community care system.

Modernize DeliveryUpdated funding models, consistent assessment approaches, flexible contracting, workforce stabilization and improved technology are used throughout the sector.

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A Roadmap to Better Home and Community CareOntario needs a health care system that delivers quality care, closer to home. Patients First: A Roadmap to

Strengthen Home and Community Care is the first phase in our plan to transform the way we deliver care

at home and in the community.

Building on Our Success

Since 2003, the Ontario government has more than doubled funding for home

care services:

visit within five days of being approved and 84 per cent of home care

patients with complex needs receive a visit from a personal support

worker (PSW) within the five-day target.

hours of personal support and homemaking services to more

support services such as meals, transportation and caregiver

support.

Ontario has more than doubled funding for

home and community care services since 2003

93% of clients receive home nursing services within 5 days

8 4 % of clients with complex needs

receive their fi rst personal support visit

within 5 daysPutting Patients First

Our government’s Patients First: Action Plan for Health Care exemplifies our commitment to putting

the needs of people and patients at the centre of our health care system. One of its four pillars is to

deliver better coordinated and integrated care in the community, closer to home. This plan builds on that

commitment. It is our roadmap to strengthen home and community care.

We know that care at home and in the community often goes well beyond the person who needs care.

There is often a circle of family, friends and neighbours involved. The expert group on home and

community care highlighted the greater need for client and family-centred care, and this advice has guided

the direction of our plan. Over the next three years, our government will work to ensure that our system

truly puts the needs of clients and caregivers at its centre.

This plan includes 10 steps toward higher quality, more consistent and better integrated home and

community care. It lays out clear timelines to achieve these goals over the next three years.

At each step, our government is committed to consulting with clients, their advocates and caregivers,

as well as with providers and leaders in the home and community care sector to ensure that all voices

are heard.

Ten Steps to Strengthen Home and Community Care1. Develop a Statement of Home and Community Care Values

Over the next year, we will consult broadly with clients, their advocates and caregivers, and with our

partners in the home and community care sector including providers, agencies and sector leaders.

Together, we will develop a statement of our shared values to guide our transformation of home and

community care, with the needs of clients and their caregivers at the centre.

Timeline for Implementation

2015 Consult with clients, caregivers and providers to develop a statement of home and community care values that puts the experience of clients and their caregivers at its centre.

2016 Finalize and publish the statement of home and community care values for use throughout the sector and in policy development.

2. Create a Levels of Care Framework

We know that we must provide greater consistency in the services

that are provided as well as greater transparency in how the needs

of individuals are assessed. This will require a bold reshaping of how

services are delivered.

Meals, transportation, day programs and more, supporting

1.46 million patients and caregivers

Working closely with our partners, clients and caregivers, we propose to

create a Levels of Care Framework to ensure services and assessments

are consistent across the province. The framework will be an easily accessible way for the public to

understand the level of care they can expect. This would represent a significant system-wide improvement,

addressing service and information gaps, two of the most commonly heard concerns when it comes to the

system of home and community care.


2015 Launch provincewide consultations with clients, caregivers, health service providers and other stakeholders to develop a Levels of Care Framework.

2016 Pilot Levels of Care in select communities across the province. As part of these pilots, we will create an online resource outlining levels of care to answer the question “what can I expect for my loved one?”

2017 Explore the implementation of Levels of Care provincewide, including support tools for providers and increased public awareness.

ease

3. Increase Funding for Home and Community Care

Our government has made it a priority to improve home and community

care. In the 2015 Budget, our government announced that we are

proposing to extend our commitment to increase funding for home and

community care by five per cent each year, investing an additional

Spending on home and community care will increase by

$750 million over the next 3 years


2015-2018 Proposed increase to funding for home and community care by five per cent annually, an increase of $750 million over three years.

4. Move Forward with Bundled Care

We know that strengthening home and community care requires better integration of the health care

services that patients receive. All health care providers must work together.

To help achieve more seamless care, our government is moving forward with a bundled care approach, in

which a group of providers will be given a single payment to cover all the care needs of an individual patient.

Building on strong local examples, we will develop a plan to roll out this approach across the province.

Sp ng on hS endidi home andd community care willll incr bby

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2015Beginning in 2014-15, increase the hourly wage of publicly funded PSWs providing personal support services in home and community care over three years.

Consult with clients, caregivers and providers to develop a statement of home and community care values that puts the experience of clients and their caregivers at its centre.

Launch province-wide consultations with clients, caregivers, health service providers and other stakeholders to develop a levels of care framework.

2016Increase the minimum wage for publicly funded PSWs providing personal support services in home and community care to $16.50/hour by April 1, 2016.

Finalize and publish the statement of home and community care values for use throughout the sector and in policy development.

Develop a one-stop online resource for information and resources available to caregivers.

Pilot levels of care in select communities across the province. As part of these pilots, we will create an online resource outlining levels of care to answer the question “what can I expect for my loved one?”

2017Explore the implementation of levels of care provincewide, including support tools for providers and increased public awareness.

2015-2018Proposed increase to funding for home and community care by five per cent annually, an increase of $750 million over three years.

Patients FirstA Roadmap to Strengthen Home and Community Care

Consult with clients, caregivers and the home and community care sector to develop a comprehensive capacity plan.

Request that health care providers test innovative approaches to bundled care in their local communities to improve coordination between hospital and home care.

Select a first wave of health care providers to test bundled care models in 2015.

Begin self-directed funding pilot projects.

Invest in more training and education programs for caregivers.

Post a draft regulatory proposal to increase nursing service maximums for public consultation.

Consult with Ontarians and stakeholders on a plan for palliative and end-of-life care.

Review the early results of the first wave of bundled care projects and develop a plan for broader implementation provincewide.

Enable caregivers to work with providers to identify their needs and the needs of their loved ones so that services and supports can be provided where needed.

New regulations to increase nursing service maximums would come into effect, subject to the necessary regulatory approvals.

Implement a comprehensive program to improve access to and equity in palliative and end-of-life care at home and in the community.

Announce a capacity plan that includes target capacity in communities across the province as well as standards for access and client experience.

Explore the implementation of self-directed funding across the province.

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2015 Request that health care providers test innovative approaches to bundled care in their local communities to improve coordination between hospital and home care.

2016 Review the early results of the first wave of projects and develop a plan for broader implementation provincewide.

5. Offer Self-Directed Care

Putting patients first means giving clients and caregivers greater say in choosing a provider and how that

provider delivers services. Over the next two years, we will begin to offer a self-directed care option, in

which clients and their caregivers are given funds to hire their own provider or purchase services from a

provider of their choice.

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2015 Begin self-directed funding pilot projects.

2017 Explore the implementation of self-directed funding across the province.

200,000 more people are benefi tting from physio, exercise and falls prevention coaching

6. Expand Caregiver Supports

Caregivers, who may include family, friends and neighbours, are critical in the journey of individuals

receiving care at home or in the community.

To better recognize caregivers’ important role and to empower both caregivers and clients, we will

introduce expanded caregiver supports. These supports will ensure caregivers have better resources

to care for their loved ones and also to take care of themselves.


2015 Invest in more training and education programs for caregivers.

2016 Develop a one-stop online resource for information and resources available to caregivers.Enable caregivers to work with providers to identify their needs and the needs of their loved ones so that services and supports can be provided where needed.

7. Enhanced Support for Personal Support Workers

Clients need to know that they are receiving care from

providers who are adequately trained and compensated

and part of a stable workforce.

We intend to continue moving forward with our plan

to enhance the wages of personal support workers

and provide other supports to improve the stability

of our PSW workforce.

Increasing the PSW hourly base wage to $16.50/hour by April 1, 2016 improves continuity of care and enhances workforce stability

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2014 -15 Increase the hourly wage of publicly funded PSWs providing personal support services in home and community care over three years.

2016 Increase the minimum wage for these PSWs to $16.50/hour by April 1, 2016.

In addition, we intend to:

employment for PSWs.

community care sector.

including how PSWs can become more involved in teams of health care

professionals to better care for clients.

In 2014, over

380,000 patients met with health care

providers via secure video conferencing,

up 23% over 2013

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8. More Nursing Services

Nurses play a critical role in home and community care. To ensure

clients have the services they need, we are proposing to increase the

maximum number of nursing visits a patient can receive and allow

Community Care Access Centres (CCACs) to exceed nursing service

maximums in certain cases, subject to necessary regulation changes.

Nurses currently make

6.5 million home visits annually

Clients who need these services most would be able to continue to receive them at home, rather than

having to be admitted to a hospital or a long-term care home.


2015 Post a draft regulatory proposal to increase nursing service maximums for public consultation.

2016 New regulations to increase nursing service maximums would come into effect, subject to the necessary regulatory approvals.

9. Provide Greater Choice for Palliative and End-Of-Life Care

Many Ontarians want to stay in their homes as long as possible.

Whether a patient wishes to receive end-of-life care at home or

in a hospice, Ontarians deserve to choose the kind of care they

want to receive.

As part of our plan, we will support greater patient choice for

palliative and end-of-life care. We will expand access and equity

in our system, establish clear oversight and accountability, and

introduce new supports for caregivers. We will also support

enhanced public education on the issue of advanced care

planning so that families are aware of the wishes of their loved

ones when it comes to palliative and end-of-life care.

Over

200,000 patients currently receive home care

after a hospital stay

Home care is provided to more than

600,000 people per year, including

27 million hours of personal support and

homemaking

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supppppport byyy 2018


2015 Consult with Ontarians and stakeholders on a plan for palliative and end-of-life care.

2016 Implement a comprehensive program to improve access to and equity in palliative and end-of-life care at home and in the community.

10. Develop a Capacity Plan

To ensure that high quality, timely and appropriate home and community care is available now and in the

future, we need a rigorous capacity plan.

Over the next three years, we will develop a capacity plan that includes targets for local communities as

well as standards for access to home and community care and for the quality of client experience across

the province.


2015 Consult with clients, caregivers, and the home and community care sector to develop a comprehensive capacity plan.

2017 Announce a capacity plan that includes target capacity in communities across the province, as well as standards for access and client experience.

Over

2,000 clinicians now have specialized

training to care for frail seniors

3 million more hours of personal

support by 201815,663

people with complex health needs receive care

through69 Health Links

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The Path Forward The 10 initiatives outlined in this document are important steps toward transforming home and community

care to ensure that clients and their families are at the centre of everything we do. This plan will result in

better care, more consistent access to care across the province, greater integration among providers and

an overall better experience for clients and their caregivers.

These initiatives represent only the first phase of our plan to strengthen home and community care in

Ontario. We know that form must follow function. We must remain focused during this first phase of our

plan on our shared goal of improving the client and caregiver experience. Our loved ones should know

what to expect when receiving care at home or in the community. This functional change must come first,

before changes to the structure of the system can be made.

As we proceed with our plan, we will continue to rely on the important contributions of our partners in the

home and community care sector, as well as clients and their caregivers and advocates. Our government

will build on our positive and collaborative relationships to ensure success. We look forward to continuing

to work together to put patients first, and provide better care for all Ontarians and their families.

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For more information visit Ontario.ca/homecare

http://Ontario.ca/homecare

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